剖宫产术前消毒阴道对术后感染的预防作用研究

Study on the effect of vaginal preparation prior to caesarean delivery on the incidence of postpartum infection

目的:研究剖宫产术前消毒阴道对术后子宫内膜炎及腹部伤口感染的预防作用。方法:选择中日友好医院2014年6月~2016年5月行子宫下段剖宫产患者665例,所有患者在孕35~37周产检或早产入院时均予阴道分泌物细菌培养。随机分成2组,研究组在术前腹部皮肤消毒时同时予阴道碘伏消毒,对照组仅予腹部消毒。比较2组产妇术后子宫内膜炎发生率及腹部伤口感染率,并根据阴道细菌培养结果,比较特定阴道细菌阳性产妇术后子宫内膜炎及腹部伤口感染的发生率。结果:研究组产妇子宫内膜炎发生率(6.6%)显著低于对照组(11.7%,P<0.05);胎膜早破患者中,研究组子宫内膜炎发生率(8.3%)显著低于对照组(22.6%,P<0.05)。对照组中1例B组链球菌阳性产妇,术后发展为严重感染;2例大肠埃希菌阳性者术后发展为子宫内膜炎。腹部切口感染2组间差异不显著(P=0.404)。结论:剖宫产术前消毒阴道可降低胎膜早破产妇术后子宫内膜炎发生率。

Objective:To study the effect of vaginal preparation prior to caesarean delivery on postpartum endometritis and abdominal wound infection.Methods:665 cases with cesarean section in our hospital from June2014 to May 2016 were selected.All of them were performed vaginal bacterial culture during the prenatal examination at 35~37 weeks of pregnancy or preterm delivery.They were randomly divided into two groups.In the study group,both the parturients’abdominal skin and their vagina were sterilized with iodophor before the operation.In the control group,only their abdominal skin were sterilized.The incidence of postoperative endometritis and abdominal wound infection rates were compared between the two groups,and the incidence of postoperative endometritis and abdominal wound infection in patients with specific vaginal bacteria were compared according to the results of vaginal bacterial culture.Results:The incidence of endometritis in the study group was significantly lower than that in the control group(6.6%vs 11.7%,P<0.05).Among patients with PROM(premature rupture of fetal membrane),the incidence of endometritis in the study group was significantly lower than that in the control group(8.3%vs 22.6%,P<0.05).One B streptococcus positive patient in the control group developed severe postoperative infection.Among the escherichia coli positive patients,2 cases in the control group developed endometritis after surgery.There was no significant difference in abdominal incision infection between the two groups(P=0.404).Conclusion:Vaginal preparation before cesarean section can reduce the incidence of endometritis after premature rupture of membranes.